Concussion Knowledge and Clinical Experience Among Athletic Trainers: Implications for Concussion Health Care Practices

Abstract

Context Athletic trainers (ATs) are heavily involved in concussion assessment and return-to-play (RTP) decision making. Despite ATs' crucial role, few researchers have directly examined ATs' knowledge of concussions or whether concussion knowledge or clinical experience affects clinical concussion-management practices. Objective To determine the overall concussion knowledge of ATs and whether concussion knowledge and clinical experience affect concussion-assessment and -management practices. Design Cross-sectional study. Setting Online survey. Patients or Other Participants Random convenience sample of 8725 (15.0% response rate [1307/8725]; certified, 15.0 ± 10.6 years) ATs surveyed from the National Athletic Trainers' Association membership. Main Outcome Measure(s) The survey collected demographics, concussion-assessment and -management tools used, and concussion knowledge (patient-clinician scenarios, signs and symptoms recognition). We used multiple logit models to determine the odds ratios (ORs) for using assessment and management tools based on signs and symptoms recognition and years of clinical experience. Results The ATs correctly identified 78.0% ± 15.1% of concussion signs and symptoms. Approximately 46% (357/770) of ATs indicated an athlete could RTP if the athlete stated he or she had a “bell rung.” Every additional year of clinical experience decreased the odds of using standardized sideline-assessment tools by 3% (OR = 0.97, 95% CI = 0.95, 0.99). The odds of using standardized sideline tools (OR = 0.98, 95% CI = 0.96, 0.99) and symptom checklists (OR = 0.98, 95% CI = 0.97, 0.99) for RTP assessment were significantly decreased for each additional year of clinical experience. No other tools used for RTP assessment were influenced by signs and symptoms recognition (P ≥ .136) or clinical experience (P ≥ .158). Conclusions The ATs with greater clinical experience had lower odds of using concussion-assessment and -management tools. Athletic trainers should frequently review and implement current consensus guidelines into clinical practice to improve concussion recognition and prevent improper management.